You Could Have Fallen Arches?

Overview

Acquired Flat Foot

A fallen arch is when an arch, even one that has always been flat, has gotten flatter. There are several reasons for this. The bottom of heel tilts toward the inside, making the inside of the ankle appear convex or bowed. The feet often appear to be rotates outward, like a duck. And the arch sags toward the ground. Fallen arches? are more than just flat feet. Having flat feet is not a disease. It is a description of the shape of the foot. Most flat feet have been like that all of the person?s life. Usually they are not painful.




Causes

If you tend to pronate, roll your foot and ankle in when you walk or run you may cause your arch to fall. Pronating your foot and ankle interferes with the normal movement of your foot. You should land on your heel first and roll through the middle of your foot. Landing on the inside of your foot stresses foot and ankle bones, tendons and ligaments. This can lead to many problems including flat feet. Your podiatrist can examine the way you land on your foot and then design orthotics to help you move correctly. It is important to wear the right shoes for an activity, to provide necessary arch support. Making these corrections can relieve symptoms.




Symptoms

Pain along the inside of the foot and ankle, where the tendon lies. This may or may not be associated with swelling in the area. Pain that is worse with activity. High-intensity or high-impact activities, such as running, can be very difficult. Some patients can have trouble walking or standing for a long time. Pain on the outside of the ankle. When the foot collapses, the heel bone may shift to a new position outwards. This can put pressure on the outside ankle bone. The same type of pain is found in arthritis in the back of the foot. The symptoms of PTTD may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change. For example, when PTTD initially develops, there is pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm, and swollen. Later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward. As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle.




Diagnosis

Podiatrists are trained in expertly assessing flat feet and identifying different risk factors and the causes for it. Initial assessment will begin with a detailed history attempting to find out if any underlying illness has resulted in this. A detailed clinical examination normally follows. The patient may be asked to perform certain movements such as walking or standing on their toes to assess the function of the foot. Footwear will also be analysed to see if there has been excessive wear or if they are contributing to the pronation of the foot. To assess the structure of the foot further, the podiatrist may perform certain x-rays to get a detailed idea of the way the bones are arranged and how the muscle tissues may be affecting them. It also helps assess any potential birth defects in a bit more detail.




Non Surgical Treatment

Treatment often consists of giving the affected foot support from underneath so that the strain is taken off it (by the use of insoles or support pads) and so symptoms are relieved. A specialist in this problem is known as a podiatrist and these do work in the NHS - ask you father's doctor whether his condition is bad enough to warrant a referral to such a specialist.




Surgical Treatment

Flat Foot

Common indications for surgery are cerebral palsy with an equinovalgus foot, to prevent progression and breakdown of the midfoot. Rigid and painful Pes Planus. To prevent progression, eg with a Charcot joint. Tibialis posterior dysfunction, where non-surgical treatment is unsuccessful. Possible surgical procedures include Achilles tendon lengthening. Calcaneal osteotomy, to re-align the hindfoot. Reconstruction of the tibialis posterior tendon. For severe midfoot collapse of the arch, triple arthrodesis may be indicated.
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